A pretty staggering sixty percent of the adult population will have symptoms of gastroesophageal reflux disease, better known as GERD, over any year of their adult life and up to 30% of people will have weekly symptoms. That’s about 7 million Americans suffering from reflux! GERD does not only affect adults. It is being diagnosed in children and even infants at rapidly increasing rates. The good news is that researchers have discovered new information about GERD and how to better manage this condition.
What is GERD?
GERD is believed to be caused by stomach acid leaking from the stomach back into the esophagus. There is a muscular flap called a sphincter at the bottom of the esophagus. It should open when food moves down the esophagus into the stomach and then close tightly to protect the esophagus from stomach acid. If the sphincter doesn’t stay closed, acid splashes the tissue of the esophagus, putting the painful burn in heartburn.
GERD can cause asthma, coughing and trouble swallowing. Chronic exposure to stomach acid in the esophagus can cause Barrett’s esophagitis, which changes the cells in the lower esophagus in a way that can be pre-cancerous.
The treatment for GERD is usually a proton pump inhibitor, such as Omeprazole, also called Prilosec, or Esomeprazole, also called Nexium. They very effectively stop the cells of the stomach from making stomach acid. They are so effective that people often stay on them, worried what will happen if they discontinue. People who use proton pump inhibitors for a period of time to heal gastritis, for example, may then stay on them for many years.
These drugs stay in the top five most prescribed or utilized medications around the world, with tens of millions of prescriptions sold for billions of dollars in sales in the US alone. Yet, proton pump inhibitors may reduce nutrient absorption and increase the risk of catching C. Difficile, a life-threatening bacterial infection, kidney disease, and other side effects.
New information about GERD
Finding a great way to suppress symptoms is crucial in medicine. PPIs have spared many people from great discomfort, but maybe it has worked so well that the underlying problem has been overlooked. Is 60% of America truly just overproducing stomach acid? Probably not.
If stomach acid were to blame for all of the symptoms of GERD, the changes scientists would see in the esophagus should look like chemical burns. Researchers in Texas took a group of patients off of their PPI, then looked at the changes to their esophagus. They did see changes in 11 out of 12 patients within 2 weeks of stopping the PPI, which showed them that the PPI was helping almost all of the patients using them.
However, the changes that were seen in these patients were not the same as would be seen in tissue exposed to acid. Researchers saw an increase in T cells and basophils. These are cells that respond to inflammation. The inflammation probably came from tissue that is not supposed to touch acid being exposed to acid. However, they were seeing inflammation, not burns, so it wasn’t simply an excess of acid. The body was also having a huge inflammation reaction.
Taking control of GERD
Reducing the body’s overall inflammation should help control GERD. The inflammatory response of the body is managed in the GI tract. Eating an anti-inflammatory diet reduces exposure to chemical additives and preservatives, which have been found to increase basophil activity. This is the same activity that researchers saw increase when a PPI was discontinued.
An anti-inflammatory diet, such as the Mediterranean diet, is not only low in triggers for inflammation, it is rich in plant based foods and lean proteins that give the immune system all of the nutrients it needs to function optimally. One more easy way to bring that inflammation down and help balance the immune system is to try a probiotic with a great balance of good bacteria. Changing to a healthy diet, and adding a healthy mix of beneficial flora to the GI tract may help people reduce their reliance on PPIs and stop the symptoms of GERD.
 Yadlapati R, Kahrilas PJ. When is proton pump inhibitor use appropriate? BMC Medicine. 2017;15:36. doi:10.1186/s12916-017-0804-x.
 Nochaiwong S, Ruengorn C, Awiphan R, Koyratkoson K, Chaisai C, Noppakun K,
Chongruksut W, Thavorn K. The association between proton pump inhibitor use and
the risk of adverse kidney outcomes: a systematic review and meta-analysis.
Nephrol Dial Transplant. 2017 Feb 23. doi: 10.1093/ndt/gfw470. [Epub ahead of
print] PubMed PMID: 28339835.
 Kang M-G, Song W-J, Park H-K, et al. Basophil Activation Test with Food Additives in Chronic Urticaria Patients. Clinical Nutrition Research. 2014;3(1):9-16. doi:10.7762/cnr.2014.3.1.9.